T Rietbergen1, P J Marang-van de Mheen1, J de Graaf1, R L Diercks2, R P A Janssen3,4,5, H M J van der Linden-van der Zwaag6, M E van den Akker-van Marle1, E W Steyerberg1, R G H H Nelissen6, L van Bodegom-Vos7. 1. Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. 2. Department of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands. 3. Department of Orthopaedic Surgery and Trauma, Maxima Medical Center, Eindhoven, The Netherlands. 4. Orthopaedic Biomechanics, Department Of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. 5. Chair Value-Based Health Care, Fontys University of Applied Sciences, Eindhoven, The Netherlands. 6. Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. l.vanbodegom-vos@lumc.nl.
Abstract
PURPOSE: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI's and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016-June 2017) and after introduction of the intervention (July 2017-December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. RESULTS: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = - 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = - 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = - 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). CONCLUSIONS: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. LEVEL OF EVIDENCE: III.
PURPOSE: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI's and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016-June 2017) and after introduction of the intervention (July 2017-December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. RESULTS: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = - 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = - 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = - 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). CONCLUSIONS: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. LEVEL OF EVIDENCE: III.
Authors: Oscar Aldridge; Yit J Leang; David S C Soon; Marty Smith; Mark Fitzgerald; Charles Pilgrim Journal: ANZ J Surg Date: 2020-12-28 Impact factor: 1.872
Authors: Romina Brignardello-Petersen; Gordon H Guyatt; Rachelle Buchbinder; Rudolf W Poolman; Stefan Schandelmaier; Yaping Chang; Behnam Sadeghirad; Nathan Evaniew; Per O Vandvik Journal: BMJ Open Date: 2017-05-11 Impact factor: 2.692
Authors: Reed A C Siemieniuk; Ian A Harris; Thomas Agoritsas; Rudolf W Poolman; Romina Brignardello-Petersen; Stijn Van de Velde; Rachelle Buchbinder; Martin Englund; Lyubov Lytvyn; Casey Quinlan; Lise Helsingen; Gunnar Knutsen; Nina Rydland Olsen; Helen Macdonald; Louise Hailey; Hazel M Wilson; Anne Lydiatt; Annette Kristiansen Journal: BMJ Date: 2017-05-10
Authors: T Rietbergen; P J Marang-van de Mheen; R L Diercks; R P A Janssen; H M J van der Linden-van der Zwaag; R G H H Nelissen; E W Steyerberg; L van Bodegom-Vos Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-06-19 Impact factor: 4.114